Provider Demographics
NPI:1093352775
Name:DR ROBIN CARSON PLLC
Entity Type:Organization
Organization Name:DR ROBIN CARSON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-960-2827
Mailing Address - Street 1:5010 E 68TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3305
Mailing Address - Country:US
Mailing Address - Phone:918-960-2827
Mailing Address - Fax:918-960-2824
Practice Address - Street 1:5010 E 68TH ST STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3305
Practice Address - Country:US
Practice Address - Phone:918-960-2827
Practice Address - Fax:918-960-2824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200010990AMedicaid
OK3652OtherLICENSE #